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Syphilis

Syphilis is a sexually transmitted bacterial infection that causes genital ulcers (sores) in its early stages. If untreated, syphilis can also lead to more serious symptoms.

An ancient disease, syphilis is still of major importance today. The Centers for Disease Control and Prevention estimates that each year 55,400 people in the United States get new syphilis infections. During 2012, there were 49,903 reported new cases.

In addition, HIV infection and syphilis are linked. Syphilis increases the risk of transmitting as well as getting infected with HIV.​

Cause

Syphilis is caused by a bacterium called Treponema pallidum.

Transmission

The most common way to get syphilis is by having sexual contact with an infected person. If you are infected, you can pass the bacteria from infected skin or mucous membranes (linings), usually your genital area, lips, mouth, or anus, to the mucous membranes or skin of your sexual partner.

The bacteria are fragile, so you cannot get syphilis from sharing food or utensils, or from using tubs, pools, or toilets.

Syphilis can be passed from mother to infant during pregnancy, causing a disease called congenital syphilis.​

Symptoms

Syphilis is sometimes called "the great imitator." This is because it has so many possible symptoms, and its symptoms are like those of many other diseases. Having HIV infection at the same time as syphilis can change the symptoms of syphilis and how the disease develops.

Syphilis (other than congenital syphilis) occurs in four stages that sometimes overlap.

Primary Syphilis

The first symptom of primary syphilis is often a small, round, firm ulcer (sore) called a chancre ("shanker") at the place where the bacteria entered your body. This place is usually the penis, vulva, or vagina, but chancres also can develop on the cervix, tongue, lips, or other parts of the body. Usually there is only one chancre, but sometimes there may be many. Nearby lymph glands are often swollen. (Lymph glands, or nodes, are small bean-shaped organs of your immune system containing cells that help fight off germs. They are found throughout your body.) The chancre usually appears about three weeks after you're infected with the bacteria, but it can occur any time from 9 to 90 days after you have been infected.

Because a chancre is usually painless and can appear inside your body, you might not notice it. The chancre disappears in about three to six weeks whether or not you are treated. Therefore, you can have primary syphilis without symptoms or with only brief symptoms that you may overlook.

If primary syphilis is not treated, however, the infection moves to the secondary stage.

Secondary syphilis

Most people with secondary syphilis have a skin rash that doesn't itch. The rash is usually on the palms of your hands and soles of your feet. However, it may cover your whole body or appear only in a few areas. The rash appears 2 to 10 weeks after the chancre, generally when the chancre is healing or already healed. Other common symptoms include

Sore throat

Tiredness

Headache

Swollen lymph glands

Other symptoms that happen less often include fever, aches, weight loss, hair loss, aching joints, or lesions (sores) in the mouth or genital area.

Your symptoms may be mild. The lesions of secondary syphilis contain many bacteria, and anyone who has contact with them can get syphilis. As with primary syphilis, secondary syphilis will seem to disappear even without treatment, but secondary syphilis can return. Without treatment, however, the infection will move to the next stages.

Latent syphilis

The latent (hidden) stage of syphilis begins when symptoms of secondary syphilis are over.

In early latent syphilis, you might notice that signs and symptoms disappear, but the infection remains in your body. When you are in this stage, you can still infect a sexual partner.

In late part of latent syphilis, the infection is quiet and the risk of infecting a sexual partner is low or not present.

If you don't get treated for latent syphilis, you may move on to tertiary syphilis, the most serious stage of the disease.

Tertiary syphilis

Even without treatment, only a small number of infected people develop the severe complications known as tertiary, or late, syphilis. In this stage, the bacteria will damage your heart, eyes, brain, nervous system, bones, joints, or almost any other part of your body. This damage can happen years or even decades after the primary stage.

Late syphilis can result in mental illness, blindness, deafness, memory loss or other neurologic problems, heart disease, and death.

Late neurosyphilis (brain or spinal cord damage) is one of the most severe complications of this stage.

Diagnosis

It can be very difficult for your healthcare provider to diagnose syphilis based on symptoms. This is because symptoms and signs of the disease might be absent, go away without treatment, or be confused with those of other diseases. Because syphilis can be hard to diagnose, you should

Visit your healthcare provider if you have a lesion (sore) in your genital area or a widespread rash

Get tested periodically for syphilis if your sexual behaviors put you at risk for sexually transmitted diseases (STDs)

Get tested for syphilis if you have been treated for another STD such as gonorrhea or HIV infection

Laboratory Tests

Your healthcare provider can diagnose early syphilis by seeing a chancre or rash and then confirming the diagnosis with laboratory tests. Because latent syphilis has no symptoms, it is diagnosed only by laboratory tests.

There are two methods for diagnosing syphilis through a laboratory.

Identifying the bacteria under a microscope in a sample of tissue (a group of cells) taken from a chancre

Performing a blood test for syphilis

If your healthcare provider thinks you might have neurosyphilis, your spinal fluid will be tested as well.

Treatment

Syphilis is easy to cure in its early stages. Penicillin, an antibiotic, injected into the muscle, is the best treatment for syphilis. If you are allergic to penicillin, your healthcare provider may give you another antibiotic to take by mouth.

If you have neurosyphilis, you may need to get daily doses of penicillin intravenously (in the vein) and you may need to be treated in the hospital.

If you have late syphilis, damage done to your body organs cannot be reversed.

While you are being treated, you should abstain from sex until any sores are completely healed. You should also notify your sex partners so they can be tested for syphilis and treated if necessary.

Prevention

To prevent getting syphilis, you must avoid contact with infected tissue and body fluids of an infected person. However, syphilis is usually transmitted by people who have no sores that can be seen or rashes and don't know they are infected.

If you aren't infected with syphilis and are sexually active, having mutually monogamous sex with an uninfected partner is the best way to prevent syphilis.

Using condoms properly and consistently during sex reduces your risk of getting syphilis.

Washing or douching after sex won't prevent syphilis.

Even if you have been treated for syphilis and cured, you can be re-infected by having sex with an infected partner.

To prevent passing congenital syphilis to their unborn babies, all pregnant women should be tested for syphilis. Most cases of congenital syphilis can be avoided with appropriate screening and treatment of pregnant women.

Complications

Pregnancy

Syphilis can cause miscarriages, premature births, or stillbirths. It can also cause death of newborn babies. Some infants with congenital syphilis have symptoms at birth, but most develop symptoms later.

Untreated babies with congenital syphilis can have deformities, delays in development, or seizures, along with many other problems such as rash, fever, swollen liver and spleen, anemia, and jaundice. Sores on infected babies are infectious. Rarely, the symptoms of early-stage syphilis may go unseen in infants and they may subsequently develop the symptoms of late-stage syphilis, including damage to their bones, teeth, eyes, ears, and brains.

HIV infection

People infected with syphilis have a two- to five-fold increase risk of getting infected with HIV. Strong evidence shows the increased odds of getting and transmitting HIV in the presence of other STDs as well. You should discuss this and other STDs with your healthcare provider.